What is the recommended dose of Lexapro (escitalopram) for adolescents?

Lexapro (Escitalopram) Dosing for Adolescents

For adolescents with depression, the recommended dose of Lexapro (escitalopram) is 10 mg once daily, with a maximum dose of 20 mg daily if needed after at least three weeks of treatment. 1

Initial Dosing and Titration

• Starting dose: 10 mg once daily (morning or evening, with or without food) 1
• Titration: If inadequate response after at least 3 weeks, dose may be increased to 20 mg daily 1
• Maximum dose: 20 mg daily for adolescents 1

Efficacy Evidence

A flexible-dose trial of escitalopram (10-20 mg/day) demonstrated effectiveness in adolescents with major depressive disorder 1. Extended treatment studies have shown that escitalopram is generally safe and results in modest improvement in efficacy for adolescents with depression 2.

Pharmacokinetic Considerations

• Escitalopram reaches maximum plasma concentrations in approximately 3-4 hours after administration 3
• Elimination half-life is about 27-33 hours, supporting once-daily dosing 3
• Steady-state concentrations are achieved within 7-10 days 3
• Adolescents do not have clinically relevant differences in pharmacokinetics compared with healthy young adults 3

Monitoring and Follow-up

After initiating treatment, regular monitoring is essential:

• Contact (either in person or by telephone) should take place after the initiation of treatment to review understanding of and adherence to the treatment plan 4
• Monitor closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of treatment or at times of dose changes 4
• Regular assessment of target symptoms should be conducted 4

Duration of Treatment

• Continue treatment for at least 6-12 months after remission to prevent relapse 5
• Periodically reassess to determine the need for maintenance treatment 1

Discontinuation

When discontinuing escitalopram:

• Implement a gradual reduction in dose rather than abrupt cessation 1
• Monitor for discontinuation symptoms (dizziness, sensory disturbances, anxiety, sleep disturbances) 5
• If intolerable symptoms occur during discontinuation, consider resuming the previously prescribed dose and decrease more gradually 1

Safety Considerations

• Screen for bipolar disorder prior to initiating treatment 1
• Monitor for emergence of adverse events, particularly:
  • Suicidal thoughts and behaviors (especially during initial treatment period) 4
  • Common side effects: nausea, headache, insomnia, diarrhea 5
  • Sexual dysfunction 5

Common Pitfalls to Avoid

1. Starting at too high a dose: Always begin with 10 mg for adolescents
2. Increasing dose too quickly: Wait at least 3 weeks before considering dose increase
3. Inadequate duration of treatment: Continuing for only acute phase rather than maintaining for 6-12 months after remission
4. Abrupt discontinuation: Always taper gradually to avoid withdrawal symptoms
5. Insufficient monitoring: Especially during the first few months of treatment when risk of suicidal ideation may be elevated

Remember that escitalopram is FDA-approved for adolescents with depression, making it one of the preferred SSRI options for this age group.